Shoulder pain: physio, scans, and when to act

The shoulder is the most mobile joint in the body, which also makes it one of the most vulnerable. A niggling ache after sport, pain that wakes you at night, or stiffness that has crept up over months — shoulder problems vary enormously, but they share one common feature: they rarely sort themselves out without some form of attention.

Common causes of shoulder pain

Understanding what's likely behind your pain can help you make better decisions about when and how to act:

• Rotator cuff problems — the four tendons that stabilise the shoulder are a frequent source of pain, whether from acute strain, overuse tendinopathy or age-related change
• Impingement — soft tissue caught between bony surfaces during arm elevation, causing a painful arc of movement
• Frozen shoulder (adhesive capsulitis) — stiffness that develops gradually, often over months, and restricts movement in all directions
• Acromioclavicular (AC) joint problems — pain at the top of the shoulder, common after falls or heavy lifting
• Referred pain — neck problems and, occasionally, other causes can produce shoulder-region symptoms

When should you see a physiotherapist?

You don't need a GP referral to access private physiotherapy. It's worth booking an assessment if:

• Pain has persisted for more than two to four weeks without improvement
• It's affecting sleep, work or your ability to do everyday tasks
• You've had an acute injury and want a clear picture of what's happened
• You've been managing it yourself but aren't making progress

An initial physiotherapy assessment at Northwest Health costs from £80 and includes a thorough clinical examination, a working diagnosis, and a plan for what comes next. Follow-up appointments are from £60.

Do you need a scan?

Many shoulder conditions can be diagnosed and treated effectively through clinical assessment alone. However, imaging is genuinely helpful when:

• The diagnosis is unclear after examination
• Symptoms haven't responded to an appropriate course of physiotherapy
• A structural problem (such as a significant rotator cuff tear) is suspected and would change the treatment plan
• You're considering whether an injection or surgical referral is appropriate

For soft tissue assessment around the shoulder, diagnostic ultrasound is often the first choice — fast, real-time and well-suited to the rotator cuff. MRI provides broader structural detail and is particularly useful for labral pathology, bone changes or complex presentations. A private shoulder MRI starts at £400 at Northwest Health and is reported by a consultant radiologist.

Ultrasound-guided injections for shoulder pain

If inflammation is a significant part of the picture — for example, with bursitis or a specific tendon condition — an ultrasound-guided injection from £200 can reduce pain enough to allow rehabilitation to progress. It's not a substitute for physiotherapy, but for some patients it's a useful step along the way.

When to seek urgent advice

Most shoulder pain is not serious, but contact a GP or seek urgent attention if you develop sudden severe pain with no clear cause, numbness or weakness down the arm, or if you've had a significant fall or trauma.

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